Effect of Time-Dose-Matched Virtual Reality Therapy on Upper Limb Dysfunction in Patients Poststroke: A Meta-Analysis of Randomized Controlled Trials

Li, Yi; Huang, Jiashang; Xiao-hong, LI; Qiao, Juan; Xin, Huang; Yang, Lining; Yu, He

doi:10.1016/j.apmr.2021.09.003

Cited by 8 publications

(4 citation statements)

References 61 publications

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“…Through subgroup analysis, Laver et al [8] pointed out that VR plus traditional rehabilitation training was highly beneficial for upper limb recovery. The same results were obtained by Fang et al [24] and Li et al [23]. Mekbib et al [25] indicated that VR rehabilitation was highly effective in improving upper limb function in patients with subacute stroke.…”

Section: Evidence Synthesis Of Subgroup Analysissupporting

confidence: 72%

“…Laver et al [8] and Mekbib et al [25] noted that in VR training with an intervention duration of more than 15 h, the intervention group showcased great improvements in upper limb dysfunction and activity limitation compared with the control group. Li et al [23] revealed that VR sessions lasting longer than 45 min for less than 6 weeks are highly beneficial to structure/function. Lee et al [29] found that VR rehabilitation required a minimum of 5 weeks to improve the daily abilities of patients.…”

Section: Evidence Synthesis Of Subgroup Analysismentioning

confidence: 99%

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Effects of Virtual Reality on the Limb Motor Function, Balance, Gait, and Daily Function of Patients with Stroke: Systematic Review

2023

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Background and Objectives: This systematic review aimed to clarify the effectiveness of virtual reality rehabilitation on physical outcomes for people with stroke. Materials and Methods: Articles were searched through PubMed, EMBASE, the Cochrane Library, the Physiotherapy Evidence Database, CINAHL, Web of Science, and ProQuest Dissertations and Theses, from inception to 30 April 2022. Methodological quality was scored using the Assessing the Methodological Quality of Systematic Reviews 2 tool. Each systematic review for the outcome of interest was assessed by two independent reviewers using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: Twenty-six articles were selected. These studies evaluated the effectiveness of virtual reality on limb motor function, balance, gait, and daily function in patients with stroke. The findings suggested a beneficial effect of virtual reality; there was a “very low” to “moderate” quality of evidence for improved limb extremity function, balance, and daily function, and a “very low” to “moderate” quality of evidence for improved gait. Conclusions: Despite widespread interest in the use of virtual reality rehabilitation, high-quality evidence for its routine use in stroke treatment is lacking. Further research is needed to determine the treatment modality, duration, and long-term effects of virtual reality on stroke populations.

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Section: Evidence Synthesis Of Subgroup Analysissupporting

confidence: 72%

Section: Evidence Synthesis Of Subgroup Analysismentioning

confidence: 99%

Effects of Virtual Reality on the Limb Motor Function, Balance, Gait, and Daily Function of Patients with Stroke: Systematic Review

2023

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“… 17 Mild adverse events (visual disturbance, upper limb pain, nausea, soreness, dizziness, headache and hypertonicity) have been documented in a few studies. 16 18 19 …”

Section: Introductionmentioning

confidence: 99%

Feasibility and efficacy of virtual reality rehabilitation compared with conventional physiotherapy for upper extremity impairment due to ischaemic stroke: protocol for a randomised controlled trial

Paul,

Elango,

Chakravarthy

et al. 2024

BMJ Open

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IntroductionApproximately half of all stroke survivors have persistent upper extremity functional impairment, leading to reduced self-care, independence and quality of life. High-intensity, task-oriented virtual reality rehabilitation improves motor recovery. However, its clinical efficacy over standard rehabilitation remains uncertain. This study aims to evaluate the feasibility and efficacy of a virtual reality-based comprehensive rehabilitation gaming system (VR-cRGS) in stroke survivors with upper extremity impairment and to characterise the structural and functional plasticity of the affected regions in the brain due to the proposed rehabilitation.Methods and analysisThis study is a multicentric, open-label, randomised controlled trial with an intention-to-treat analysis. A total of 162 patients will be enrolled in two academic institutes in India that specialise in stroke care. Patients with a first-ever ischaemic stroke (18–70 years and 1–6 months of stroke onset) with upper extremity impairment with 1 and 1+ grades of spasticity as per the modified Ashworth Scale and 3, 4 or 5 stages on Brunnstrom recovery staging will be enrolled. They will be randomised (1:1) into two treatment groups to receive 12 weeks of training either on VR-cRGS or on conventional physiotherapy. The primary feasibility outcome is compliance with the treatment. The primary efficacy outcome is the functional recovery of the upper extremity assessed by the Fugl-Meyer Assessment-Upper Extremity and Wolf Motor Function Test. The secondary outcomes are the Barthel Index and the 36-item Short-Form Health Survey. Multimodal brain imaging will be done in all enrolled patients at baseline and post-treatment to evaluate the structural and functional connectivity changes. The outcome measures will be analysed using paired t-tests or non-parametric tests.Ethics and disseminationThe study has been approved by the Institutional Ethics Review Board of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India (SCT/IEC/1415/AUGUST-2019) and the National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India (NIMHANS/IEC (BS and NS DIV.)/32nd Meeting/21). All participants will sign an informed consent form prior to participation. The study results will be disseminated through scholarly publication.Trial registration numberCTRI/2021/11/038339.

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“…[1][2][3] For example, incorporating technologies such as virtual reality therapy may increase the dose of training and enable transfer of skills from the clinical setting to the real-world for patients recovering from stroke. [4][5][6][7][8][9][10][11] Given the potential advantages of including emerging technologies into rehabilitation care, it is important that hospitals and other rehabilitation providers continuously review products as they are developed and identify specific technologies or products that fit the needs of the patients they care for.…”

mentioning

confidence: 99%

A Novel Way to Objectively Review Emerging Rehabilitation Technologies

Cook

McLaughlin

Johnson

et al. 2023

Am J Phys Med Rehabil

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Technology-enhanced rehabilitation can improve access to training activities in multiple care delivery settings and may improve patient outcomes. However, the rate at which rehabilitation technology is being developed makes it difficult for healthcare systems to keep pace with the volume of products emerging in this space. Formal processes are needed to help healthcare systems review products as they emerge and to determine whether they should be incorporated into clinical practice. Here, we describe an approach to reviewing emerging rehabilitation technologies as performed by the Center for Emerging Rehabilitation Technology at our institution. Developed using an iterative approach, the rehabilitation technology review process used by the Center for Emerging Rehabilitation Technology team classifies technologies into the following three categories: (1) for clinical deployment, (2) for innovation in product development/product-market fit testing, and (3) for research, for example, a sponsored clinical trial. We describe the processes used to evaluate, categorize, investigate, and integrate rehabilitation technology, share our experience with the review process, and make recommendations for other institutions who may wish to implement rehabilitation technology into clinical practice.

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Effect of Time-Dose-Matched Virtual Reality Therapy on Upper Limb Dysfunction in Patients Poststroke: A Meta-Analysis of Randomized Controlled Trials

Cited by 8 publications

References 61 publications

Effects of Virtual Reality on the Limb Motor Function, Balance, Gait, and Daily Function of Patients with Stroke: Systematic Review

Effects of Virtual Reality on the Limb Motor Function, Balance, Gait, and Daily Function of Patients with Stroke: Systematic Review

Feasibility and efficacy of virtual reality rehabilitation compared with conventional physiotherapy for upper extremity impairment due to ischaemic stroke: protocol for a randomised controlled trial

A Novel Way to Objectively Review Emerging Rehabilitation Technologies

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